Artificial Turf Injuries

Artificial turf may seem like a great alternative to natural grass, but looks are deceiving.  Artificial turf was introduced in the 1960’s to increase playing surface durability, provide an indoor surface that was easy to maintain and provide a surface for urban children to play on.  Despite these advantages, artificial turf has resulted in higher injury rates to the knee, ankle and toe.

In a study involving the NFL artificial turf injury between 2000-2009, there was a 22% higher rate for knee and ankle injuries compared to natural grass.  The rate of ACL injury was 67% higher.  Game related high ankle sprains in the NFL, which is a rare and unusually season-ending injury increased by 31% on artificial turf as well.  In another NFL study published in 1990, 83% of turf toe injuries were sustained on artificial turf.

The shoe-playing surface interface has been proposed as the cause of these increased injury rates.  Increased friction between these surfaces creates more torque on the foot, ankle and knee, especially during cutting or pivoting.  Shoe companies have experimented with turf shoe sole and upper sole material, cleat length, size, pattern and location to decrease these injuries.  Due to lack of evidence with long-term well designed studies, there is no consensus as to the best shoe for artificial turf.  We do know, however, that shoes with more cleats on the heel that forefoot have lower torques than the opposite.  Edge cleats have higher torques than flat, conical and pivot- disk cleats.  Small cleats result in less torque than elliptical or bladed cleats.  Shoes with rigid upper soles increase stiffness during foot rotation as opposed to a more pliable upper sole.  Increased stiffness increases ankle and knee injuries.

Artificial surfaces are attractive to administrators because of decreased long term maintenance and cost.  The athlete that plays on artificial turf has an increased risk of knee, ankle and toe injuries.  Careful selection of shoe wear may decrease these injuries.